COMPLAINT FORM (Discrimination, Anti-Bullying, and Anti-Harassment)
Name of Complainant:
Are you filling out this form for yourself or someone else (please identify the individual if you are submitting on behalf of someone else):
Who or what entity do you believe discriminated against, harassed, or bullied you (or someone else)?
Date and place of alleged incident(s):
Names of any witnesses (if any):
Nature of discrimination, harassment, or bullying alleged (check all that apply):
National Origin/Ethnic Background/Ancestry
Political Party Preference
In the space below, please describe what happened and why you believe that you or someone else has been discriminated against, harassed, or bullied. Please be as specific as possible.
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Forest City Community Schools.